Sudden death. Though not uplifting, it's nonetheless an important topic to consider from a Christian perspective. The events of the last couple of months - the terrorist atrocities in both Manchester and London together with the tragic Grenfell tower fire - bring the issues into stark relief. In my professional life, working with a Helicopter Emergency Medicine Service (HEMS) and in an Emergency Department, I am sadly well acquainted with sudden death.
I have often been asked 'do you get used to dealing with sudden death?'; the answer is both yes and no. Yes, because you develop strategies to help you manage challenging situations and delivering the worst news. No, because I don't think you can ever get used to the raw human grief that cascades from loved ones when they hear those irrevocable words that their child, parent, partner, brother, sister or important other has died, particularly when it is unexpected.
Over the years the sense of injustice and anguish often associated with sudden death is, I have to admit, an area that has caused me to struggle with my faith - indeed I spent ten years in a spiritual wilderness seeking to answer the question, 'How can I have faith in a God of love when I see such anguish and pain?' I will come back to the question later. Along this journey a number of observations have helped me in my faith and in my limited understanding about sudden death.
Reflections on sudden death
Humans as spiritual beings
It took me a while to rationalise that death is an absolute transition. At the point of death, when the last breath has been taken, the person is gone - replaced by the empty shell of a former life, devoid of spirit. Breath, of course, is fundamental to life. In biblical terms the Hebrew word ruach means wind, breath or spirit of God, the Holy Spirit (pneuma is the corresponding Greek word). Ruach is also used in reference to breath or the human spirit. Similarly, soul appears to be a deeply spiritual part of us. Often in the scriptures references to soul are linked to heart, anguish, rejoicing, yearning and finding rest. It would seem that it is the part of our inner being where we relate to God. Simply, in the departure of the spirit, the person ceases to be the person; all that is left is the physical body.
Transition from body to person
Another question is whether there is a feeling of detachment during resuscitation. Again my answer would be both yes and no. On the one hand, there is little cognitive space to consider 'who' it is you are resuscitating; you have a job to do. Whilst resuscitating, the individual seems to have no context. Yet, on the other hand, you soon become aware of the individual's context, whether in the pre-hospital field when you suddenly become aware of belongings that connect them to people or places or in the hospital context when you meet their next of kin. Then the individual becomes a person, with context, family, life and purpose.
The exception is the resuscitation of colleagues or their relatives. It is difficult to detach yourself when you know the person or are connected to them. This presents unique challenges professionally and emotionally.
Perhaps the strangest phenomenon in the last decade is the connection to the individual's wider life made through the mobile phone. It is now common for an individual's phone to be ringing whilst you are resuscitating them, or after they have died. The phone bears the callers identification, the parent, partner or significant other, who will soon be confronted by a starkly different reality. It is a moment of connection that is both tangible and surreal.
Death by suicide is increasing. Suicide and injury or poisoning of unknown intent is the leading cause of death for both males and females from age 5-34, for males it remains the leading cause of death until the age of 49 (Office for National Statistics, 2015). It is the area of sudden death I find most challenging.
Sadly, I have often been engaged in resuscitating young males who have ended their life by hanging. It is the saddest thing to have to inform relatives of their deaths. The mental anguish that drives individuals to take their own lives must be intolerable; the devastation and psychological 'injury' to the loved ones is often considerable.
Tragically, I have a number of clinical colleagues who have ended their lives by suicide. It is a stark reminder that as healthcare professionals we are not immune to mental illness. Indeed, we are at considerable risk. It is incumbent upon us all to be aware of our own wellbeing and mental health, and importantly those around us. I draw comfort from the Psalms (Psalm 31, 42 and 43 for example); so often the Psalmist cries out to the Lord in anguish, often expressing feelings of utter despair or depression and the Lord answers. We can rely on God at these times of extreme challenge.
Lessons for life
Keep short accounts
I have lost count of the times that loved ones have mentioned their regret on parting on poor terms. The issue, which caused an argument and one party leaving before resolution, is often so trivial in the greater scheme of life. Their lives have changed forever by the sudden death of their loved one. So often their grief is made worse by the feeling of guilt and regret, the parting words perhaps sharp or cutting, negative rather than affirming, were the last words shared.
Ephesians 4:26, 'In your anger do not sin: do not let the sun go down while you are still angry, and do not give the devil a foothold' resonates in these situations. This small principle is one I have tried hard to adopt in my Christian life, I try not to let situations where I have been wrong or been wronged fester.
Comfort those who mourn
This is one of the greatest privileges as well as challenges of my job: to be there at times of absolute devastation and provide what comfort you can. For the individual who has died there is little more that can be done; the focus now is on those who cared for them. I think by now I have witnessed every possible reaction to sudden death; anger, denial, verbal and physical outbursts, laughter of disbelief and overwhelming grief to name a few. I will never get used to that rawness of human reaction we so often see. This is testament to the power of love and relationship between humans, again to me evidence of spiritual roots of connection.
I am always struck by the passage in scripture where Jesus wept at the death of Lazarus. He knew that he would raise him from death, and yet he wept with those who mourned. I have witnessed many senior colleagues weep with those who mourn in the resus room. Of course, uncontrollable grief would not be appropriate, but there is something important about human connection and sharing sadness even when you have not known the person.
Providing comfort and human connection can be difficult depending on the nature or circumstances of death. For example, we are sometimes treating both the perpetrator of an alleged crime and the victims. I have often had to remind myself that the individual is made in the image of God and dearly loved by him.
Perhaps some of the most challenging times have been supporting people who are on their own as they die. Holding the hand of a person who is dying is perhaps one of the greatest privileges of our roles. There are individuals who have no significant other to be with them at such a poignant time; just a legal guardian to inform of their passing. As the church should we, could we, do more?
I have attended a number of funerals of friends, colleagues and children of colleagues. Some died suddenly, others after short illnesses. Whilst these have been celebrations of life, there is a tangible difference between those who died who were known to have a faith and those who did not; a difference in sense of hope and finality.
I am always struck by the words of affirmation shared, of admiration and value made clear in the eulogies and stories told. Did those individual know how much they were loved and celebrated? Do people really know what we think of them and how we value them? Certainly my experience of the fragility of human existence has driven me to be clearer in my affirmation of others, expressing what they mean to me. There are numerous references to building others up in the Bible.
The challenge for us is to ask whether those around us know how they are valued and loved. Tell them today.
Making sense of sudden death
As I alluded to at the beginning of this article, unanswered questions about suffering and sudden death caused me to question my faith. The suffering and pain seemed juxtaposed to the concept of a loving God who is in control of the world. At the end of those ten wilderness years, I concluded that rather than these concepts being incongruous, it is only through faith in a God of love, one who is in control of this world that you can make any sense of sudden death or draw any comfort from it. For without faith one is left with no hope, no sense of purpose just a sense of futility that this fragile human existence is all that there is - if that were the case what would be the point in life?
Job, who suffered extraordinarily, often asked God 'Why?'; he never got an answer. I have become comfortable with knowing that there are many questions that we will not answer in this life; in other words I am more comfortable with those 'grey' areas that questions in life raise.
Am I still saddened by sudden death? Does it still trouble me? Yes, is the simple answer, but I draw great comfort from two bible passages in particular:
For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord.
And hope for the future - a new heaven and new earth:
'Look! God's dwelling-place is now among the people, and he will dwell with them. They will be his people, and God himself will be with them and be their God. He will wipe away every tear from their eyes. There will be no more death or mourning or crying or pain, for the old order of things has passed away.'
Dealing with death is a reality in our roles as healthcare professionals, how we respond to it and how it affects each one of us will be different. Considering sudden death and learning from it has been part of my journey, I hope these reflections, in some small way, might help as you face life's challenges ahead.